Between 2 and 12 April 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths. Cases are listed by date of reporting, with the most recent case listed first.

Details of the cases are as follows:

An 82-year-old male from Hail city developed symptoms on 26 March and was admitted to hospital on 2 April. Since the patient did not show signs of improvement, he was transferred to a hospital in Riyadh city on 4 April. The patient, who had comorbidities, passed away on 12 April. Investigation of contacts in the 14 days prior to the onset of symptoms is ongoing.

A 65-year-old female from Riyadh city developed symptoms on 3 April and was admitted to hospital on the same day. The patient, who had comorbidities, passed away on 5 April. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.

A 66-year-old, non-national male from Makkah city developed symptoms on 27 March and was admitted to hospital on 3 April. The patient visited a private health centre for an unrelated medical condition on 1 April. Currently, he is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to known risk factors in the 14 days prior to the onset of symptoms is ongoing.

A 51-year-old, non-national, male health worker from Jeddah city developed symptoms on 28 March and was admitted to hospital on 29 March. The patient has comorbidities. He has history of contact with a laboratory-confirmed MERS-CoV case that was reported in a previous DON on 9 April (case n. 3). The patient did not provide care to any of the MERS-CoV cases that were admitted to the hospital where he works in during the 14 days prior to the onset of symptoms. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, the patient is in stable condition in a negative pressure isolation room on a ward.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 3 previously reported MERS-CoV cases. The cases were reported in previous DONs on 9 April (cases n. 2, 5) and on 20 March (case n. 14).

Contact tracing of household contacts and healthcare contacts is ongoing for these cases.

Globally, WHO has been notified of 1106 laboratory-confirmed cases of infection with MERS-CoV, including at least 421 related deaths.

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Since the 1st of April the Saudi MOH has only announced 5 new MERS cases, a remarkable reduction from this time last year when KSA was embroiled in their largest outbreak on record (see chart below).

Why, after a strong start, this year has (thus far) played out differently is unknown. Better infection control practices in hospitals may be a factor, and it is possible that the warnings regarding avoiding camel contact are being heeded.

But since we lack a clear understanding of how the virus is spreading in the community, there may well be other factors at work here we simply haven’t recognized.

Normally we’d get answers to these questions from a case-control study, where epidemiologists would compare laboratory-confirmed cases to a large number of controls, matched for age, sex, and by neighborhood. By examining their respective exposures against their outcomes, patterns of risk are often revealed.